HOPE Guidance Manual v1.02, Item F2100

Timepoint(s) Item Completed

Admission (ADM)

Item-Specific Instructions

• Item completion should be based on what is included in the clinical record.

• Review the clinical record for information regarding discussion of patient preference for life-sustaining

treatment other than CPR.

• Consider care processes and discussions documented in the clinical record that took place during preadmission or educational visits, as well as those during the admission assessment.

• Review all response choices before making a selection.

• Use the date on which the discussion first occurred.

A. Was the patient/responsible party asked about preferences regarding life-sustaining

treatment other than CPR?

• Code 0, No, if there is no documentation that the hospice discussed (or attempted to discuss)

preferences regarding life-sustaining treatment other than CPR with the patient or responsible party.

o This applies to situations where there is no documentation that a discussion occurred or was

attempted with the patient or responsible party. This could happen if the patient was unable to

discuss and/or the responsible party was unavailable.

• Code 1, Yes, and discussion occurred, if there is documentation that the hospice discussed

preferences regarding life-sustaining treatment, other than CPR with the patient or responsible party.

o This applies to situations where there is documentation that the hospice brought up the topic of life-sustaining treatment, other than CPR and engaged and/or had a conversation with the patient, the

responsible party, or both. The conversation does not have to result in the patient stating a

preference for or against the use of life-sustaining treatments, other than CPR.

• Code 2, Yes, but the patient/responsible party refused to discuss, if there is documentation

that the hospice asked about preferences regarding life-sustaining treatments, other than CPR, but the

patient or responsible party refused to discuss or was unable to discuss. The hospice was not successful

in engaging the patient and/or responsible party in a discussion.

o This applies to situations where there is documentation that the hospice attempted to have a

conversation with the patient and responsible party, but both the patient and responsible party

explicitly refused to discuss the topic with the hospice (e.g., “I don’t want to talk about this.”), or the

patient was unable to discuss because of their clinical status and the responsible party explicitly

refused to discuss.

B. Date the patient/responsible party was first asked about preferences regarding life-sustaining treatments other than CPR.

• Enter the date the hospice first discussed (or attempted to discuss) patient preferences regarding life-sustaining treatment other than CPR.

• Multiple discussions regarding the use of life-sustaining treatments other than CPR may be documented

in the clinical record.

• Completion of this item is based on the first dated discussion about preference regarding life-sustaining

treatment other than CPR that appears in the clinical record.

Coding Tips

• There is no comprehensive list of life-sustaining treatments. Documentation in the clinical record

indicating that a member of the hospice staff or interdisciplinary group (IDG) attempted to discuss

preference for any life-sustaining treatment other than CPR (for example, ventilator support, tube

feeding, dialysis, blood transfusion, antibiotics, intravenous [IV] fluids) is sufficient to code either of the

following for F2100A:

o 1, Yes, and discussion occurred.

o 2, Yes, but the patient/responsible party refused to discuss.

• Evidence of a discussion could be documented in the clinical record or via a POLST order or equivalent.

• A newly completed order or form that is completed after the admission to hospice or during a

preadmission visit is sufficient provided there is evidence of involvement from the patient/responsible

party (e.g., signature of the patient/ responsible party, or documentation that preference was confirmed

with patient/responsible party).

• Orders alone, without evidence of discussion or involvement from the patient/responsible party, are not

sufficient to code “Yes” for F2100A.

• For pre-existing orders or forms signed in a prior care setting, the hospice should re-affirm the patient’s

preferences and document them in the clinical record.

Examples

1. Patient admitted on 08-01-2025. Clinical note dated 08-01-2025 shows, “Had discussion with the patient

about preference for use of prolonged IV fluids; the patient was hesitant and stated they weren’t sure and

wanted to discuss later. Told the patient we could discuss at a later date.”

Coding: F2100A: Was the patient/responsible party asked about preference regarding the use of any

life-sustaining treatment other than CPR? would be coded 1, Yes, and discussion occurred. F2100B:

Date the patient/responsible party was first asked about preference regarding the use of any life-sustaining treatment other than CPR: Enter “08-01-2025.”

Rationale: The most appropriate response option is “1” because although the patient did not express a

clear preference regarding the use of prolonged IV fluids, a discussion did occur.

2. Patient admitted 08-01-2025. The clinical record for the patient includes an order from the prior care

setting, “no life-sustaining treatments desired,” which is dated 07-15-2025. There is no discussion

documented in the clinical record on this topic.

Coding: F2100A: Was the patient/responsible party asked about preference regarding life-sustaining

treatments other than CPR? would be coded 0, No. Skip to Item F2200, Hospitalization Preference.

Rationale: Although the patient has a recently dated order regarding life-sustaining treatment

preferences, it was signed in a prior care setting. There is no documentation in the hospice clinical

record to indicate that the hospice re-confirmed the patient’s preferences. If a statement such as “desire

to avoid all forms of life-sustaining treatments confirmed with the responsible party, patient’s daughter”

was included, that would be sufficient to select response Code 1, Yes, and discussion occurred.